Health in emergencies

18-month-old Nabil Rebh receives oxygen from a tank while his mother sits beside him on the bed comforting him and another woman stands at her own child's bedside. Basra, Iraq.

Emergencies, both natural and humanitarian (arising from political strife or conflict) have major consequences on the health of the affected populations. Children and women are particularly vulnerable to malnutrition, disease and violence. In the past decade, an estimated 2 million children have died as a result of armed conflict alone. This is largely due to the interruption of existing health and social services. This is often compounded by population displacement, lack of access to food and other essential commodities, overcrowding, and poor water and sanitation facilities. Excess morbidity and mortality thus results from the indirect causes of conflict or natural disasters, such as malnutrition and communicable diseases.

Children under five years of age have the highest mortality rates in emergency situations. Of the countries with the world’s highest rates of under five mortality, seven are affected by conflict or its aftermath. Approximately 75% of these deaths are due to communicable diseases. Diarrheal diseases, acute respiratory infections (ARI), malaria, measles and malnutrition are the major childhood killers in these settings. Other communicable diseases like meningitis, HIV/AIDS and typhoid fever can also cause substantial morbidity and mortality. A majority of these deaths occur in the early stages of an emergency and can be prevented by the timely implementation of appropriate cost-effective public health interventions.

Current evidence shows that preventive services such as immunizations for measles and other vaccine preventable diseases and provision of insecticide treated nets for malaria prevention along with early diagnosis and treatment of diarrhea (with ORS and Zinc), ARI (with appropriate antibiotics) and malaria (with Artemisin combination therapy) can substantially and rapidly reduce mortality in emergencies.

How does UNICEF Help?

In emergency situations, the main objectives of UNICEF’s interventions are to: (1) prevent mortality and reduce morbidity and suffering among children and women during the “onset” phase of an emergency, when health threats are greatest and service capacity is weakest; and (2) assure the quick restoration of peripheral health services and public health programmes and contribute to a sustainable post-emergency health care system.

Through its Core Commitments for Children in Emergencies (CCCs), UNICEF aims to promote access to essential quality health services in collaboration with partners. UNICEF’s emergency health and nutrition interventions, as stated in the CCCs, are categorized in two phases, the first six to eight weeks and the period after the initial response.

First six to eight weeks

Rapid assessment within the first 48-72 hours to determine:

Programmatic needs in all sectors.

UNICEF’s capacity to operate in the given context and fulfill its mandate.

Vaccination of all children aged 6 months – 14 years against measles including critical inputs such as cold chain equipment, operational support, training and social mobilization.

At the outset, UNICEF’s efforts are to identify and utilize existing local health capacity for the implementation of emergency health activities.

UNICEF works in close cooperation and coordination with partner agencies including other UN agencies, government agencies, and non-government governmental organizations (NGOs). The Inter Agency Standing Committee adopted the “cluster leadership approach” in emergencies as a part of the humanitarian reform process, based on gaps identified in humanitarian response during the Humanitarian Response Review conducted in 2005. This approach is meant to strengthen the ability of agencies to respond effectively in emergencies through stronger coordination, improved predictability and increased accountability. UNICEF is fully supports the humanitarian reform process and the cluster approach led by WHO. With its substantial operational presence in most countries at national and sub-national levels, UNICEF has a major role to play in ensuring a coherent and effective health response in emergencies.

UNICEF monitors and evaluates its activities in emergencies to ensure that it meets international quality standards in humanitarian response such as The SPHERE Project guidelines. In addition, lessons learned from previous experiences feed into UNICEF’s ongoing efforts to improve the quality of future emergency programming.

In order to achieve the Millennium Development Goals (MDGs), particularly MDG4, UNICEF ensures that its emergency health interventions are linked with longer term efforts towards scaling up child survival activities, particularly in countries with high mortality in children under five years of age. The aim is to incrementally expand the emergency health package of services to a more comprehensive package of child survival services as a country transitions from an emergency programme to a development programme.

The Sphere Project (external link), launched by a group of humanitarian agencies including UNICEF, has developed a Humanitarian Charter and universal minimum standards for assistance: water supply and sanitation, nutrition, food aid, shelter and site planning and health services.

In the case of an epidemic outbreak of a vaccine-preventable disease, UNICEF, as one of the world’s largest buyers of vaccines, can respond quickly to raising vaccine demands in a certain country. UNICEF is a member of the International Coordinating Group (external link) on vaccine provision for epidemic meningitis outbreak.

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